Cognitive reserve

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Dementing processes such as Alzheimer’s disease (AD) were originally considered purely pathology-driven. Stern developed the concept of cognitive reserve (CR) based on observations that lifetime “exposures” such as education, occupation, and late-life leisure activities could reduce the risk of developing dementia. The concept of CR posits that such exposures can lead to differences in the resilience or plasticity of cognitive processes, resulting in different levels of susceptibility to functional impairment due to aging, pathology, or other neurological problems. Subsequently, Stern demonstrated that individuals with the same amount of underlying AD pathology had vast differences in clinical severity based on these exposures. The concept of CR has had a major impact on our understanding of cognitive aging and dementing processes and raises testable hypotheses for intervention.